Creating communicatively accessible healthcare environments: Perceptions of speech-language pathologists (summary)



The World Health Organisation's definition of disability identifies two separate but interacting causes of disability; a person's impairment and their environment. The level of any individual's communication disability will depend on not only the severity of their communication impairment but also on factors such as the familiarity of their communication partner, levels of background noise, presence or absence of communication aids, complexity of spoken and/or written language etc. Environmental factors can have both positive and negative effects on the ability to communicate effectively.

Many people with different types of communication impairment have reported difficulties in communicating about their healthcare and in healthcare environments. The effects of this can be significant, ranging from an inability to have basic needs met to being at risk of experiencing serious, preventable adverse events. It has also been found that people with communication disabilities are less satisfied with their healthcare, possibly meaning they are less likely to trust of follow healthcare recommendations.

Evidence is growing of the need to make changes in healthcare settings to support people who have communication difficulties, but it is unclear whose responsibility this should be. This study investigated the views of speech and language pathologists (SLPs) in one Australian state about whether they felt able to take on the role of modifying the wider healthcare environment and whether they believed it was part of their remit alone or should be shared more widely with other professionals.

What did they do?

Fifteen SLPs working in hospital settings took part in a series of focus groups to consider whether they felt that working to create a communicatively accessible healthcare environment would be useful and, if so, who within the settings should address the issue. The focus groups were videoed and recorded and the data gathered was analysed into a number of themes.

What did they find?

The researchers found that the SLPs who took part in the study had a broad view of a communicatively accessible environment which would benefit a wide range of people, beyond those with aphasia or intellectual disability. They also identified a wide range of possible benefits for service providers including SLPs.

The findings were divided into two main sections each with a number of sub-themes. The first was the SLPs beliefs about the benefits of creating communicatively accessible healthcare settings, the second their perceptions of how to create these environments, including the role of the SLP.

The participants that those who might benefit potentially included all patients who used the settings, those with low levels of literacy or for whom English was not a first language, as well as people with specific communication impairments. It was also suggested that there would be benefits for healthcare administrators in improving person-centred care and reducing adverse events and complaints, and that all healthcare providers would benefit including SLPs who might benefit from improved perceptions of their role by others and from the opportunity to develop more communication resources to be widely shared in the community as well as hospital settings.

When considering how the creation of communicatively accessible environments could be achieved three main subthemes were identified; having the necessary resources easily available on wards at all times, having skilled, knowledgeable and supportive healthcare workers who see the resources as relevant and who are willing to use them and having systems in place to support the setting and evaluate the effectiveness of the strategies used.


Although the SLPs felt that their role in creating a communicatively accessible environment was important they believed there needed to be a wider range of professionals and systems involved if it was to be successful. Further work is needed to look into the development of 'communication resource toolkits' for use in hospitals and to engage all staff in training and support for using the systems, particularly where enabling patients to communicate more effectively might impact on the workload of nursing or healthcare staff by increasing the demands made on them.

The SLPs recognised the 'great potential of communicatively accessible environments' but felt that they could not create these without wider support. The authors agree with the suggestion that there could be a role for a 'public health communication professional' to develop better provision for patients who have communication disabilities.


The participants in the study were a self-selected group who were interested in the topic being discussed, they therefore might not reflect the views of a wider range of SLPs. It is possible that in focus groups participants felt pressured to agree with the majority view, however the opportunity to provide anonymous feedback on the written summaries of group discussions should have reduced this possibility.

Things you may want to look into:

Communication boards in critical care: patients' views

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Light Technology Augmentative Communication for Acute Care and Rehab Settings

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

Nursing the patient with severe communication impairment

Added to site Dec 2015